Background: Otitis media represents a major health concern in Australian Indigenous children (‘Indigenous children’), which has persisted, despite public health measures, for over 30 years.

Methods: Global searches were performed to retrieve peer-reviewed and ‘grey’ literature investigating the epidemiology of and risk factors for otitis media in Indigenous children, published between 1985 and 2012.

Results: In Indigenous children, the prevalence of otitis media subtypes is 7.1–12.8 per cent for acute otitis media, 10.5–30.3 per cent for active chronic otitis media and 31–50 per cent for tympanic membrane perforation. The initial onset of otitis media in Indigenous children occurs earlier and persists for longer after the first year of life, compared with non-Indigenous children. Indigenous children are colonised by otopathogens more frequently, at younger ages and with a higher bacterial load. Poor community and domestic infrastructure, overcrowding and exposure to tobacco smoke increase the risk of otitis media in Indigenous children; however, the availability of swimming pools plays no role in the prevention or management of otitis media.

Conclusion: Despite awareness of the epidemiological burden of otitis media and its risk factors in Indigenous children, studies undertaken since 1985 demonstrate that otitis media remains a significant public health concern in this population.